HomeMy WebLinkAbout11-09-12 (2) 1505610105
REV-1500 EX (oz-u )(FI)
PA Department of Revenue OFFICIAL USE ONLY
Pennsylvania
Bureau of Individual Taxes
PO BOXZ806o> `" `" "`~`"~` County Code Year File Number
INHERITANCE TAX RETURN ~
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Harrisburg, PA t~i28-0601. ~
RESIDENT DECEDENT t,Ij U 7 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
200-24-0748 08/11 /2012 04/17/1932
Decedent's Last Name Suffix Decedent's First Name MI
Rhine Helen C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
OID 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
OD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Thomas P. Gleason (717) 532-3270
First Line of Address
49 West Orange Street
Second Line of Address
Suite 3
City or Post Office State ZIP Code
Shippensburg PA 17257
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Correspondent's a-mail address: tomgleason@tomgleasonlaw.com
REGISTER OF WILLS USE ONLY .,
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNAK(RE OF P PONSIBLE FOR FILING RETURN DATE
~~ 11/08/2012
ADDRES
9944 Possum Hollow Road, Shippensburg, PA 17257
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONL
1505610105
Side 1
1505610105 J
1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
oecedenes Name: 200-24-0748
RECAPITULATION
1. Real Estate (Schedule A) .......................................... ... L 0.00
2. Stocks and Bonds (Schedule B) ............ ....................... ... 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ! 0.00
4. Mortgages and Notes Receivable (Schedule D) ........................ ... 4. ' 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 27,146.01
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 13,143.38
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7 0.00
8. Total Gross Assets (total Lines 1 through 7) .......................... ... 8. 40,289.39
9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. 7,480.80
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. 2,555.40
11. Total Deductions (total Lines 9 and 10) .............................. ... 11. ' 10,036.20
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 30,253.19
13. Charitable and Governmental BequestslSec 9113 Trusts for which -
an election [o tax has not been made (Schedule J) ..................... ... 13. 0.00
_.
14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 30,253.19
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15. 0.00
16. Amount of Line 14 taxable _
at lineal rate X .0 45 30,253.19 16. 1,361.39
17. Amount of Line 14 taxable
at sibling rate X .12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 18. 0.00
19. TAX DUE ....................................................... .. 19. 1,361.39
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Helen C. Rhine
STREETADDRESS _ _ _ __ __ _ _- --
122 North Fayette Street
--- -
CITY - - __ _- 'STATE ,ZIP
Shippensburg PA ' 17257
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 1,361.39
2. Credits/Payments
A. Prior Payments 0.00
___ --- --
B. Discount 68.07
Total Credits (A+ B) (2) 68.07
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,293.37
Make check payable to: REGISTER OF WILLS, AGENT.
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ................................................................................... ....... ^
b. retain the right to designate who shall use the property transferred or its income ..................................... ....... ^
c. retain a reversionary interest ........................................................................................................................ ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "intrust for" or payable-upon-death bank acwunt or security at his or her death? ........ ...... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a benefciary designation? .................................................................................................................. ...... ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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For dates of death on or after July 1, 1994, antl before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined,
under Section 9102, as an individual who has ai least one parent in common with the decedent, whether by blood or adoption.
REV-ISoB EX+ (o8-IZ)
pennsylvania SCHEDULE E
L~] DEPARTMENT OF REVENUE CASFI~ BANK DEPOSITS & MISC.
INHERITANCE TA%RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
HELEN C. RHINE
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
If more space is needed, use additional sheets of paper of the same size.
AGREEMENT OF SALE
THIS IS AN AGREEMENT made this ~ 5~ day of ~UI/t~WW1~
2012, by and between, Jerry E. Rhine, Executor for the Estate of Helen C. Rhine, of
Shippensburg, Pennsylvania, hereinafter referred to as Seller, and Randy and Debra
Goshorn, husband and wife, of Newville, Pennsylvania, hereinafter referred to as Buyers.
WITNES5ETH:
FOR AND IN EXCHANGE OF MUTUAL CONSIDERATIONS, the receipt
whereof is hereby acknowledged, and intending to be bound by the provisions hereof, it
is agreed as follows:
1. Seller shall sell, grant, and convey to Buyers who shall purchase and accept
conveyance of the single-wide mobile home located at 122 North Fayette
Street, Shippensburg, Pennsylvania. This Agreement is for the mobile home
only with no land.
2. Buyers shall pay to Seller for the above described property the sum of Three
Thousand Five Hundred ($3,500.00) Dollars.
A. At the time this agreement is executed, Buyers will not give Seller a down
payment, but will be subject to the payment terms set forth in Paragraph 2.B.
below and the terms of the attached lease agreement.
B. Buyers shall pay $400.00 on the 1 S` day of each month for eight months and
$300.00 on the 1 S` day of the ninth month at which time the mobile home shall
be paid for in fiall. Title of said mobile home will be transferred from Seller to
Buyers after the last payment is made.
3. Buyers and Seller shall both secure policies of insurance protecting the
premises and its belongings against loss by fire and casualty and extended
coverage and all proceeds of such policies shall inure to the benefit of the
parties as their interest may appear. Buyers further agree that insurance
policies shall be obtained for the protection of the personal properties,
possessions and liabilities of the Buyers and Seller, as their interest may
appear. In the event of a loss, both parties agree to cooperate in the settlement
of any insurance claims so as to provide payment to the parties for their
respective losses.
4. In the event of tender of good and marketable title by Seller at the time of
settlement and Buyers' failure to purchase for any reason whatsoever, then
and in that case, this Agreement shall be deemed to be null and void and
Buyers shall forfeit, as liquidated damages, all funds paid.
5. It is understood and agreed that the rights of the Buyers set forth herein are
personal to the Buyers and shall not in any manner be transferred, assigned or
otherwise inure to the benefit of anyone other than Buyers.
6. It is further understood and agreed that the rights granted hereto are
conditioned and contingent upon Buyers' full and faithful performance
according to the terms and conditions of the Lease Agreement attached hereto.
If Buyers fail to cure any default under such Lease Agreement within ten days
after notice by Seller, the rights of the Buyers granted hereby shall
immediately terminate and the Agreement shall be deemed to be null and void
and Buyers shall have no right to a return or reimbursement of any rent paid.
7. It is further understood and agreed that Seller has made no agreements,
promises or representations respecting Buyers' right to purchase the subject
mobile home except those specifically stated herein. The mobile home in all
respects is being sold "AS IS".
IN WITNESS WHEREOF, the parties bind themselves, their heirs, executors,
administrators, successors and assigns by signing this agreement the day and year first
above written.
Witness:
..
~,
~~ ~. ~ ~.
(SEAL)
Je R 'ne as Executor of the
Estate of Helen C. Rhine (SELLER)
Goshorn (BUYER)
(SEAL)
(SEAL)
EXHIBIT A
LEASE
THIS AGREEMENT made and entered into in Shippensburg, Cumberland
County, Pennsylvania, this 1 sc day of ('~OJ~~,,,, , 2012 by and
between, Jerry E. Rhine, Executor for the Estate of Helen C. Rhine, of Shippensburg,
Pennsylvania, hereinafter referred to as "Landlord", and Randy and Debra Goshorn,
husband and wife, of Newville, Pennsylvania hereinafter jointly and severally referred to
as "Tenant";
WITNESSETH, THAT:
In consideration of the mutual covenants herein contained it is understood and
agreed by and between the parties as follows:
1. LEASED PREMISES: LEASE TERM:
In consideration of the timely payment of rent by Tenant and the faithful
performance by Tenant of all of the obligations set forth herein, Landlord grants
to Tenant the right to use and occupy the mobile home located at 122 North
Fayette Street, Shippensburg, Pennsylvania, hereinafter referred to as the "Leased
Premises", for residential purposes only for a term commencing on
~' , 2012 and terminating no later than Sebaa..1 ~ ,
2013. The term Leased Premises shall be meant to refer to and include the mobile
home as well as all other improvements on the property. Tenant agrees to pay to
Landlord the sum of $400.00 per month on the 1St day of each month for eight
months and $300.00 on the 1St day of the ninth month at which time this lease
shall end. The above-rent payments will be applied to the Tenant's purchase of
the mobile home pursuant to the foregoing Purchase Agreement. Rent shall be
due and payable at the home of landlord in said monthly amount, payable in
advance on the first day of each month. If payment thereon is not made within 10
days from the 1St of the month, Tenant agrees to pay a late fee of Five ($5.00)
Dollars per day for every day the rent is not paid thereafter, in addition to the rent
due.
It is understood and agreed that time is of the essence as to the payment of rent
and that acceptance of delinquent installments by Landlord shall not constitute a
waiver or modification of Landlord's right to timely payment of any subsequent
installments. Late payments of rent shall also be considered a breach of the
associated agreement of sale and sufficient to void the Seller's duties hereunder.
2. CONDITION OF PREMIESES: MAINTENANCE &
IMPROVEMENTS
Tenant acknowledges that Tenant has personally inspected the Leased Premises
and that the same is in a clean, safe, and habitable condition as of the date the
lease term begins. It is understood and agreed that Tenant shall occupy the
Leased Premises in a careful, safe and lawful manner at all times and that Tenant
shall redeliver possession thereof to the Landlord upon termination of Tenant's
tenancy in as good a condition and repair as Tenant received it, excepting only
reasonable and customary wear and tear. Tenant shall keep the Leased Premises
free and clear of all snow, ice and refuse and shall maintain all lawns and
shrubbery in a neat and presenting condition. Tenant shall maintain the interior,
exterior and grounds in a clean, safe and functional condition. Tenant shall
maintain at Tenant's expense all plumbing, electric, heating, or other systems to
remain in a safe and functional condition. All improvements, alterations, or
additions become the property of the Landlord on default. Tenant shall not make
any alteration, improvement or modification to the building, including but not
limited to structural change, change of floor covering and type, change of wall
color, painting of stained woodwork or removal of paint from woodwork or other
major repairs without the express consent in writing of Landlord.
3. FIXTURES.
Anything installed upon or affixed to the Leased Premises, which cannot be
removed without damage to the Leased Premises, shall be considered a fixture
and shall be deemed a part of the Landlord's mobile home. Any item not
immediately removed from the Leased Premises upon termination of the tenancy
or default shall be conclusively presumed to have been abandoned by the Tenant
and shall become the property of the Landlord.
4. UTILITIES AND SERVICES
Tenant shall assume and promptly pay the cost of utilities and all other services
used by Tenant upon the Leased Premises, including but not limited to electricity,
gas, refuse, water, and sewer charges. All utilities and services shall be put in the
name of Tenant and bills for such utilities and services shall be kept current.
Failure to pay any utility or service bill in a timely manner as set forth shall be
considered a default of this lease and the associated agreement of sale.
5. TAXES.
It shall be Tenant's responsibility to reimburse the Landlord for any and all
property taxes, both general and special, with respect to the Leased Premises until
such time that Tenant completes the purchase of said premises pursuant to the
preceding Agreement of Sale.
6. CASUALTY INSURANCE.
Landlord and Tenant shall both maintain a policy of property and casualty
insurance or other optional coverage protecting the Leased Premises against
casualty and fire and all proceeds of such policies shall inure to the benefit of
Landlord. Tenant further agrees that an insurance policy shall be obtained for the
protection of the personal properties, possessions and liabilities of the Tenant and
the Landlord, as their interest may appear.
7. EMINENT DOMAIN.
In the even the entire Lease Premises is appropriated under eminent domain or
similar authority, this Lease shall be deemed canceled and Tenant shall not be
liable for further rent. In the event that only a portion of the Lease Premises is
appropriated, Tenant may elect (a) to cancel this Lease and be released from the
obligation to pay further rent; or (b) continue the tenancy in which case the rent
due after such appropriation is completed shall be ratably reduced based upon the
value of the portion of the Leased Premises which are appropriated.
8. INSPECTION.
Landlord shall be entitled to enter upon the Leased Premises from time to time to
inspect the condition thereof and compliance with the terms of this lease upon
reasonable prior notice to the Tenant and in a reasonable manner. Twenty four
hours is deemed to be a reasonable notice. Landlord shall be entitled to enter
upon the Leased Premises at any time when the circumstances reasonably require
such entry to prevent imminent damage and destruction thereof.
9. ASSIGNMENT: SUBLETTING.
Tenant shall not assign or sublet the residence located on the Leased Premises.
Furthermore, Tenant shall not accept roomers or boarders in the primary residence
of the Leased Premises. Any assignment or subletting of the primary residence
shall render this Lease void and shall be considered a default.
10. INJURY, LOSS, DAMAGE.
"Tenant shall indemnify and hold Landlord harmless from any claims for injury,
loss, or damage to person or property upon the Leased Premises, including
reasonable attorney's fees.
11. WAIVER: MODIFICATION.
It is understood and agreed that Landlord's failure to terminate this Lease because
of any breach on the part of Tenant shall not be considered a waiver of any
subsequent breach or a modification of the terms and conditions of this Lease. It
is further understood and agreed that this Lease may be modified only by written
rather than verbal agreement.
12. INVALIDITY: SEVERABILITY.
It is understood and agreed that all of the covenants and conditions of this Lease
are severable and that, if any provision is determined to be invalid or
unenforceable, such invalidity or unenforceability shall not effect any other
provision.
13. QUIET ENJOYMENT.
If the Tenant and Tenant's heirs, successors and permitted assigns shall promptly
and faithfully perform each of the covenants and conditions set forth in this Lease,
Landlord shall warrant and defend Tenant in the quiet enjoyment and peaceable
possession of the Leased Premises during the Lease term without disturbance by
the Landlord or any other person lawfully claiming the Leased Premises.
14. LANDLORD'S REMEDIES AND RECOVERY OF POSSESSION.
Landlord may file a complaint to evict the Tenant and to recover any part or the
entire rents due until expiration of the term of the Lease and any other charges
due hereunder of whatsoever kind and nature, together with any and all damages
caused by, and incurred as a consequence of Tenant's default including
reasonable attorney's fees and court costs if Tenant fails to pay rent when due or
fails to comply with any other provision of this Lease. Upon the failure of the
Tenant upon demand to satisfy any rent reserved and due or upon forfeiture of the
Lease for breach of its conditions or upon the termination of the term of the
Lease, Landlord may institute an action to recover possession of the Leased
Premises.
15. WAIVER OF NOTICE TO QUIT.
THE TENANT HEREBY SPECIFICALLY WAIVES HIS (OR HER) RIGHT
TO RECENE THE 30-DAY NOTICE OR ANY "NOTICE TO QUIT" THE
LEASED PREMISES IN ACCORDANCE WITH THE PENNSYLVANIA
LANDLORD TENANT ACT. THE TENANT FURTHER UNDERSTANDS
THAT THE LANDLORD SHALL HAVE THE ABSOLUTE RIGHT TO
DEMAND THE IMMEDIATE VACATION OF THE PREMISES BY THE
TENANT AND THAT THE LANDLORD MAY EXERCISE THIS RIGHT AT
ANY TIME THAT THE LANDLORD FEELS THAT ANY TERM (S) OF THE
LEASE MAY HAVE BEEN VIOLATED.
15. ENTIRE AGREEMENT: PARTIES BOUND.
This Lease shall be deemed to contain all of the promises, conditions, and
understandings of the parties with respect to the Leased Premises and shall
become binding upon and inure to the benefit of the parties as well as their
respective heirs, executors, successors and permitted assigns.
IN WITNESS WHEREOF, we have hereunto set our hands to several
counterparts of this instrument, each of which is being deemed an original, on the
date first stated above.
Witness:
`~
.~
(SEAL)
ine (LANDLORD)
1Jebra ~iosriorn (t tJNAN1)
5~~~~ AG~~~c.~~ ~-~~
Sollenbergers -Shippensburg
Sollenbergers -Shippensburg
408 E King St
Shippensburg,PA 17257
(717) 532-3764
For:
KRISTI LYNN MINNICH
8 CUMBERLAND DR
MECHANICSBURG, PA 17050
717-7667-818
Record #: 92193
Date: 08/23/2012
Time: 05:58'PM
Clerks Initials: TAM
Online Title
Title Number 50021127
WID 12236 3427 018400
VIN 1G4AG55M9T6483994
Year 1996
Make BUIC
Odometer 45807
Tag Number JCP4863
I/We swear that Uwe have applied for the above item(s).
Sworn and subscribed to before me on 23-Aug-2012.
Seal
SalesJLTse Tax
Motor Vehicle Fees 58.50
Other Fees 0.00
State Payment Type
Total State Fees Cash
178.50
Service Fees
Messenger/Processing Fee-- --- -- ____._25.00:_ _
Electronic Processing Fee 5.00
Plate Fee 10.00
Notary/Clerical Fee 5.00
Copy/Fax Fee 0.00
MV03 Form Fee 0.00
MV13 Form Fee 0.00
Other Fee 0.00
Messenger Payment Type Cash
Total Service Fee 45.00
Total Amount Due 223.50
Amount Tendered 223.50
Chant=e Due 0.00
No Refunds on Service or Notary fees. We are not
responsible for the work the State fails to process.
Welcome to Sollenbergers -Shippensburg
Your Direct Connection with PENNDOT, "Online", State & Service Fees Apply
08/23/2012 05:58 PM
REV-i5o9 EX+ (oJ-JO)
~ pennsylvania
- DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
HELEN C. RHINE
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Barbara Bakner 8137 Tomstown Road Daughter
Waynesboro, PA 17268
e' Jerry E. Rhine
C.
JOINTLY OWNED PROPERTY:
9944 Possum Hollow Road
Shippensburg, PA 17257
Son
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF nNANCIAL INSTfTUT10N AND BANK ACCOUNT NUMBER OR SIMIIAR
IDENTTFYIN6 NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DFATH
VALUE OF ASSET "k OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. 08109/91 M&T (f/n/a Dauphin Deposil Bank) CD# 98002 4,128.32 50 2,064.16
2. B. 07/22/85 M&T. (f/n/a Dauphin Deposit Bank) CD# 935625 5,097.90 50 2,548.95
3. B. 07122/85 M&T Savings Account ND. 021000001218363 17,060.54 50 8,530.27
TOTAL (Also enter on Line 6, Recapitulation) I $ 13,143.38
[f more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
~ P Pennsylvania SCHEDULE H
oEPARrnENrorREVErvuE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN C. RHINE
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Dugan Funeral Home & Crematory 2,796.50
2. Parklawns Memorial Gardens & Mausoleum 1,040.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) _.
Street Address
City _ ______ State ZIP
Year(s) Commission Paid:
2. Attorney Fees: 2,600.00
3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City _ _ __ -_- _ State Z]P
Relationship of Claimant to Decedent
4. Probate Fees: 175.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• Estate Publication in Shippensburg News Chronicle 88.25
B. Estate Publicaton in Cumberland Law Journal 75.00
e. Penelec Electric bill for maintaining residence until sold 201.15
i o. Shippensburg Borough for dumpster to clean out home 99.40
~ ~. Lot rent for decedent's mobile home (2 months at $190/mo) 380.00
tz. Jason Clough for lawn maintanence at decentant's residence 25.00
TOTAL (Also enter on Line 9, Recapitulation) $ 7,480.80
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
~ pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TA%RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN C. RHINE
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (O1-10)
~ Pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF. FILE NUMBER:
HELEN C . RHINE
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1• Jerry E. Rhine 9944 Possum Hallow Rd., Shippensburg, PA 17257 lineal (son) 1 /3
2. Sharon Hill 3146 White Church Road, Chambersburg, PA 17202 lineal (daughter) 1 /3
3. Barbara Bakner 8137 Tomstown Road, Waynesboro, PA 17268 lineal (daughter) 1 /3
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, HELEN C. RHINE, of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all
prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of alt my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes and administration costs shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath all of my property, be it real,
mixed or personal, to my children, Jerry Rhine, Sharon Hill and Barbara Bakner in
equal shares, share and share alike, per stirpes.
THIRD: I nominate and appoint my children, Jerry Rhine, Sharon Hill
and Barbara Bakner Executors of this my Last Will and Testament.
FOURTH: I direct that no bond be required of any Executors namned
herein.
IN WITNESS WHEREOF, I, HELEN C. RHINE to this my Last Will and
Testament, set my hand and official seal, this day of May 2002.
\.(~.y C`, ~~2,t~.2.e _. (SEAL)
Helen C. Rhine
Sworn to and subscribed, declared and
Published by Helen C. Rhine, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
1
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COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF CUMBERLAND
I, Helen C. Rhine, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I
signed it willingly and that I signed it as my free and voluntary act for the
purpose therein expressed.
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H~ elen C. Rhine
Sworn to and acknowledged, before me,
By Helen C. Rhine, Testatrix
This ~ day of May 2002.
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~~~M ~Y 2:e..~ . % , .
Notary Public
Notarial S N tart Public
Dawn Marie Shoop,
Shippensburg Boro, Cue bFeb 5 20o'~J4
My Commission Exp'
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, H. Anthony Adams and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that she signed willingly and that she
executed it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the Will as
witnesses, and that to the best of our knowledge and belief the Testatrix was at
the time at least eighteen (18) or more years of age and of sound mind and
under no constraint or undue influence.
Sworn to and subscribed before me by,
H. Anthony Adams and Sharon Coleman Adams,
The witnesses, this 'day of May 2002.
~I
Notary Public
Notarial Seal
Dawn Marie Shoop, Notary Public
Shippensburg Boro. Cumberland County
My Commission Expires Feh. 5, 2004